Pitfalls and fallacies of cat scratch disease serology: evaluation of

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1: J Clin Microbiol. 1997 Aug;35( Cool

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Comment in:
J Clin Microbiol. 1998 Dec;36(12):3741-2.

Pitfalls and fallacies of cat scratch disease serology: evaluation of
Bartonella henselae-based indirect fluorescence assay and enzyme-linked
immunoassay.

Bergmans AM, Peeters MF, Schellekens JF, Vos MC, Sabbe LJ, Ossewaarde
JM,
Verbakel H, Hooft HJ, Schouls LM.

Research Laboratory for Infectious Diseases, National Institute of
Public
Health and the Environment, Bilthoven, The Netherlands.

The diagnostic value of the detection of immunoglobulin G (IgG) and IgM
by
Bartonella henselae-based indirect fluorescence assay (IFA) and
enzyme-linked immunoassay (EIA) for the diagnosis of cat scratch
disease
(CSD) was evaluated. The IFA was performed either with B. henselae that
was
cocultivated for a few hours with Vero cells or with noncocultivated B.
henselae as the antigen. Additionally, the performance of a Bartonella
PCR
hybridization assay based on the 16S rRNA gene was determined and
compared
with those of the serologic assays. The study group consisted of 45
patients
suspected of suffering from CSD by fulfilling one or more of the
classical
criteria. The specificities of the immunoassays were set at > or = 95%
by
analysis of sera from 60 healthy blood donors. It is shown that the
sensitivities of the IgG assays are very low (40.9% for the IFA with
noncocultivated B. henselae as antigen) and that those of the IgM
assays are
higher (71.4% for the EIA) for patients who fulfilled two or more
criteria
for CSD. The IgM EIA showed the highest sensitivity: 71.4% in patients
with
two or more criteria for CSD and 80.6% for patients with a positive
Bartonella PCR result. The results indicate that the specificities of
both
IFA and EIA IgG serologies and the sensitivity of the IFA IgM serology
need
to be improved. The PCR hybridization assay showed a sensitivity of
86.4%
for patients who fulfilled two or more criteria for CSD and 100% for
seven
patients who fulfilled three or more criteria. The kinetics of IgG and
IgM
antibody production were studied in 18 patients with CSD on the basis
of a
positive B. henselae IFA IgM serology. The results indicate that there
is no
standard course of anti-B. henselae IgG and IgM production in patients
with
CSD, because some patients produced high levels of both IgG and IgM,
others
produced only high levels of IgM, and a few patients produced only low
levels of antibodies.

PMID: 9230358 [PubMed - indexed for MEDLINE]

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